Atrial fibrillation: Clinical clues, keys to the work-up

Atrial fibrillation (AF) may occur with any type of heart disease. Some of the most commonly associated conditions are hypertensive heart disease, coronary artery disease, cardiomyopathies, and congestive heart failure. Noncardiac conditions that may coexist with AF include chronic obstructive pulmonary disease, pulmonary emboli, pheochromocytoma, and hyperthyroidism. Clinical situations that might trigger AF include slow heart rates, as seen in patients with sick sinus syndrome, and high-catecholamine states, as seen in the perioperative period. Patients with AF may experience dyspnea, palpitations, fatigue, dizziness, chest pain, or strokes. The ECG is essential in the diagnosis of AF; a transthoracic echocardiogram and an assessment of thyroid function should routinely be obtained as well.